• diversity
• femoroacetabular impingement
• hip
• hip arthroscopy
• hip/pelvis/thigh
• machine learning

• femoroacetabular impingement syndrome
• hip arthroscopy
• outcome
• patient-reported outcome measures

• Femoroacetabular impingement
• Hip arthroscopy
• Machine learning
• Outcome prediction
• Revision surgery

Current literature shows no clear answer on the question how to manage the capsule after hip arthroscopy. Regarding patient reported outcome measures there seems to be no difference between capsular repair or unrepaired capsulotomy.

To evaluate and compare the integrity of the hip capsule measured on a magnetic resonance imaging (MRI) scan after capsular repair or unrepaired capsulotomy.

A case series study was performed; a random sample of patients included in a trial comparing capsular repair vs unrepaired capsulotomy had a postoperative MRI scan. The presence of a capsular defect and gap size were independently evaluated on MRI.

A total of 28 patients (29 hips) were included. Patient demographics were comparable between treatment groups. There were 2 capsular defects in the capsular repair group and 7 capsular defects in the unrepaired capsulotomy group (P = 0.13). In the group of patients with a defect, median gap sizes at the acetabular side were 5.9 mm (range: 2.7-9.0) in the repaired and 8.0 mm (range: 4.5-18.0) in the unrepaired group (P = 0.462). At the muscular side gap sizes were 6.6 mm (range: 4.1-9.0) in the repaired group and 11.5 mm (range: 3.0-18.0) in the unrepaired group (P = 0.857). The calculated Odds ratio (OR) for having a capsular defect with an increasing lateral center-edge (CE) angle was 1.12 (P = 0.06). The OR for having a capsular defect is lower in the group of patients that underwent a labral repair with an OR of 0.1 (P = 0.05).

There is no significant difference in capsular defects between capsular repair or unrepaired capsulotomy. Regarding clinical characteristics our case series shows that a larger CE angle increases the likelihood of a capsular defect and the presence of a labral repair decreases the likelihood of a capsular defect.

• Hip
• Arthroscopy
• Magnetic resonance imaging
• Capsule
• Thickness

Patients with femoroacetabular impingement syndrome (FAIS) are offered hip arthroscopic surgery to decrease hip pain, improve their function, and decrease development of hip osteoarthritis (OA). Nonetheless, long-term follow-up data are few.

To investigate patient-reported outcomes, clinical tests, reoperations, and radiographic status 5 years after primary hip arthroscopy in patients with FAIS.

Case series; Level of evidence, 4.

A total of 60 patients (age, 36 ± 9 years; 63% female) diagnosed with FAIS were included in the study and followed for 5 years after hip arthroscopy. Follow-up included Copenhagen Hip and Groin Outcome Score (HAGOS); Hip Sports Activity Scale; and clinical tests (flexion, adduction, internal rotation [FADIR]; flexion, abduction, external rotation [FABER]; and psoas muscle/tendon major pain provocation). Radiographic evaluation included lateral joint-space width (LJSW) and Tönnis classification for hip OA. Reoperations and conversion to total hip replacement (THR) were recorded. We calculated the proportion of patients who exceeded the minimal important change (MIC), achieved the Patient Acceptable Symptom State (PASS), and were within the 95% reference interval of age- and sex-matched persons with no hip problems. Changes were investigated using paired t tests.

Compared with preoperatively, all HAGOS subscales were improved substantially 5 years after surgery (mean, ≥21 points; P < .001), and 67% to 89% of patients reported improvements exceeding MIC. Between 56% and 80% achieved PASS, but only 7% to 24% reached the 95% reference interval for the HAGOS subscales. A total of 36% had a positive FADIR test and 25% had a positive FABER test, which were improvements compared with preoperatively (P < .001 for both). Patients with a positive FADIR test had significantly worse HAGOS subscales. Six patients (10%) had a THR since their primary hip arthroscopy. In the remaining patients, the mean LJSW was decreased (-0.4 mm; P = .043), and hip OA had worsened in 9 patients (23%; P = .003).

Five years after surgery, the majority of patients experienced HAGOS improvements exceeding MIC while also showing an acceptable PASS. However, clinical tests, participation in physical activities, and quality of life indicated that many patients still experience hip problems.

NCT04590924 (ClinicalTrials.gov identifier).

Racial disparities within the field of orthopaedics are well-documented in the spinal surgery, knee arthroplasty, and hip arthroplasty literature. Not much is known about racial differences in patients with sports medicine–related hip disabilities.

To investigate whether differences exist between African American and non-Hispanic White (White) patients evaluated for hip disabilities.

Cross-sectional study; Level of evidence, 3.

We performed a multicenter retrospective cohort study of 905 patients who were evaluated over a 1-year period for hip-related orthopaedic concerns. Patient demographic data, disability characteristics, and hip radiographic findings were obtained from electronic medical records. We also obtained data on whether patients were offered physical therapy, magnetic resonance imaging (MRI), and/or surgery. Comparisons by race and insurance status were evaluated using univariate and multivariate analyses.

African Americans comprised a significantly lower proportion of the patients evaluated for hip-related disabilities compared with Whites (6.5% vs 93.5%; P < .001). A significantly smaller proportion of African Americans with hip disabilities was recommended for surgery than White patients (35.6% vs 54.6%; P = .007). Cam deformities were more common in White vs African American patients (39.7% vs 23.7%; P = .021), as were labral tears (54.1% vs 35.6%; P = .009). Logistic regression demonstrated that neither race nor insurance status were significant determinants in surgery recommendations. Conversely, race was a determinant of whether an MRI was performed, as White patients were 2.74 times more likely to have this procedure. There were no differences with respect to obtaining an MRI between private and Medicaid insurance.

Compared with White patients, there were differences in both the proportion of African Americans evaluated for hip-related disabilities and the proportion receiving a surgery recommendation. African Americans with sports medicine–related hip issues were also less likely to obtain an MRI. With regard to observed pathology, African American patients were less likely to have cam deformities and labral tears than White patients.

Dynamic radiostereometric analysis (dRSA) enables precise non-invasive three-dimensional motion-tracking of bones for assessment of joint kinematics. Hereby, the biomechanical effects of arthroscopic osteochondroplasty of the hip (ACH) can be evaluated in patients with femoroacetabular impingement (FAI).

The aim was to investigate the pre- and postoperative range of motion (ROM) and the CT bone volume removed (BV) after ACH. We hypothesize increase in ROM 1 year after surgery.

Thirteen patients (6 female) with symptomatic FAI were included prospectively. The patient’s hips were CT-scanned and CT-bone models were created. Preoperative dRSA recordings were acquired during passive flexion to 90°, adduction, and internal rotation (FADIR). ACH was performed, CT and dRSA were repeated 3 months and 1 year postoperatively. Hip joint kinematics before, and 3 months and 1 year after ACH were compared pairwise. The bone volume removal was quantified and compared to change in ROM.

Mean hip internal rotation, adduction and flexion were all unchanged after ACH at 1-year follow-up (p > 0.84). HAGOS scores revealed improvement of quality of life (QOL) from 32 to 60 (p = 0.02). The BV was between 406 and 1783 mm³ and did not correlate to post-operative ROM.

ACH surgery in FAI patients had no impact of ROM at 1-year follow-up. QOL improved significantly. This indicates that the positive clinical effects reported after ACH might be a result of reduced labral stress and cartilage pressure during end-range motion rather than increased ROM.

Therapeutic prospective cohort study, level II.

• Arthroscopic osteochondroplasty
• FAI
• Femoroacetabular impingement
• Hip
• Hip biomechanics

To report the minimum 5-year outcome after hip arthroscopy with labral repair in adolescents. From 2011 to 2014, 29 consecutive patients with a mean age 16.3 years (range 12.7–19.8 years) underwent hip arthroscopy treatment for femoroacetabular impingement syndrome. Patient-related outcome measures (PROMs) including modified Harris Hip Score (mHHS), Visual Analog Scale (VAS) for pain and Copenhagen Hip and Groin Outcome Score (HAGOS) were used preoperatively and at follow-up (FU). Percentage of patients achieving minimum clinically important difference (MCID) and substantial clinical benefit (SCB) for mHHS and HAGOS were determined. Mean FU was 6.7 years (range 5–9.6 years), and a 100% FU was accomplished. Significant improvements were seen for all PROMs at FU in patients not having a periacetabular osteotomy (PAO) with VAS pain score improving from mean 62 to 9, mHHS from 58 to 94 and HAGOS improved in all subgroups. For mHHS, SCB changes were achieved by 76% and MCID by 76% of the patients. Percentage of patients achieving MCID for HAGOS subgroups were 81% for pain, 67% for symptoms, 76% for physical function in daily living, 76% for physical function in sport and recreation, 81% for participation in physical activities and 81% for hip-related quality of life. Two patients had revision hip arthroscopy. PAO was later performed in three patients. The risk of further surgery with center edge (CE) bony edge (CEB) <30° was 42% and 0% with CEB ≥30°. Adolescents having hip arthroscopy with labral repair and resection of cam and pincer morphology achieve significant improvements at mean 6.7 years of FU. CEB < 30° increases the risk of further surgery.

• Adverse events
• FAI syndrome
• Hip arthroscopy

• Arthroscopy
• Femoroacetabular impingement
• Hip
• Peripheral compartment

• FAIS
• Femoroacetabular impingement syndrome
• Hip arthroscopy
• PROM
• Patient-reported outcome measures

• HAGOS
• PASS
• Patient Acceptable Symptom State
• hip arthroscopy
• iHOT-33
• patient-reported outcome measure

• Hip arthroscopy
• Register
• Revision

• Delphi technique
• Femoroacetabular impingement
• Guidelines
• Hip
• Multimodal Imaging

• Consensus
• Femoracetabular Impingement/diagnostic imaging
• Hip
• Hip Joint/diagnostic imaging
• Humans
• Magnetic Resonance Imaging

• Central sensitization
• Hip arthroscopy
• Pain
• Pain catastrophizing

• FAI
• acetabular overcoverage
• femoroacetabular impingement
• hip arthroscopy
• pincer hip

• Acetabulum/diagnostic imaging
• Acetabulum/surgery
• Adult
• Arthroscopy
• Femoracetabular Impingement/surgery
• Hip Joint/diagnostic imaging
• Hip Joint/surgery
• Humans
• Middle Aged
• Retrospective Studies
• Treatment Outcome
• Young Adult

• Elite athletes
• Femoroacetabular impingement
• Hip arthroscopy
• Return to sport

• Hip arthroscopy
• Physical activity
• Qualitative study
• Rehabilitation

• Femoroacetabular impingement
• Hip arthroscopy
• Participation
• Physical activity
• Sport

• Accelerometry
• Adult
• Arthroscopy/methods
• Exercise
• Female
• Femoracetabular Impingement/surgery
• Hip Joint/surgery
• Humans
• Male
• Patient Reported Outcome Measures
• Prospective Studies
• Sedentary Behavior
• Self Report
• Sports
• Treatment Outcome

• arthroscopic surgery
• hip joint
• outcome measure
• quality of life

There is no information to define variations in hip arthroscopy outcomes at 2-year follow-up using the Hip Outcome Score (HOS). To offer a tiered system using HOS absolute substantial clinical benefit (SCB) and patient acceptable symptomatic state (PASS) scores for 2-year hip arthroscopy outcome assessment. This was a retrospective review of patients having hip arthroscopy for femoroacetabular impingement and/or chondrolabral pathology. On initial assessment and 2 years (±2 months) post-operatively, subjects completed the HOS activity of daily living (ADL) and Sports subscales, categorical self-rating of function and visual analog scale for satisfaction with surgery. Receiver operator characteristic analysis identified absolute SCB and PASS HOS ADL and Sports subscale scores. Subjects consisted of 462 (70%) females and 196 (30%) males with a mean age of 35.3 years [standard deviation (SD) 13] and mean follow-up of 722 days (SD 29). SCB and PASS scores for the HOS ADL and Sports subscales were accurate in identifying those at a ‘nearly normal’ and ‘normal’ self- report of function and at least 75% and 100% levels of satisfaction (area under the curve >0.70). This study provides tiered SCB and PASS HOS scores to define variations in 2-year (±2 months) outcome after hip arthroscopy. HOS ADL subscale scores of 84 and 94 and Sports subscale scores of 61 and 87 were associated with a ‘nearly normal’ and ‘normal’ self-report of function, respectively. HOS ADL subscale scores of 86 and 94 and Sports subscale score of 74 and 87 were associated with being at least 75% and 100% satisfied with surgery, respectively. Level of evidence: III, retrospective comparative study.

Hip arthroscopy is a common surgical intervention for young and middle-aged adults with hip-related pain and dysfunction, who have high expectations for returning to physical activity following surgery. The purpose of this review was to evaluate the impact of hip arthroscopy on physical activity post-arthroscopy.

A systematic search of electronic databases was undertaken in identifying studies from January 1st 1990 to December 5th 2019. The search included English language articles reporting physical activity as an outcome following hip arthroscopy in adults aged 18-50 years. Quality assessment, data extraction and synthesis of included studies were undertaken.

Full text articles (n = 234) were assessed for eligibility following screening of titles and abstracts (n = 2086), yielding 120 studies for inclusion. The majority (86%) of the studies were level 4 evidence. One study reported objective activity data. The most frequently occurring patient-reported outcome measure was the Hip Outcome Score-sport-specific subscale (HOS-SS, 84% of studies). Post--arthroscopy improvement was indicated by large effect sizes for patient-reported outcome measures (standard paired difference [95% confidence interval] −1.35[−1.61 to −1.09] at more than 2 years post-arthroscopy); however, the majority of outcome scores for the HOS-SS did not meet the defined level for a patient-acceptable symptom state.

The current level of available information regarding physical activity for post arthroscopy patients is limited in scope. Outcomes have focused on patients’ perceived difficulties with sport-related activities with a paucity of information on the type, quality and quantity of activity undertaken.

Level IV, systematic review of Level 2 through to Level 4 studies

• Activity
• Hip-arthroscopy
• Outcomes
• Rehabilitation
• Sport

Femoroacetabular impingement (FAI) is a predisposing factor for secondary osteoarthritis of the hip joint. The two extensively described impingement mechanisms of FAI are CAM and Pincer-type. Initially managed conservatively, operative intervention should be offered to the persistently symptomatic patient. The measurement of the alpha angle is considered a standard method of assessing the severity of pathology in Cam-type FAI on pre-operative plain radiographs. The radiological correction of the alpha angle has not been previously compared between different surgical approaches. We hypothesize that there is no difference in alpha angle correction between Ganz surgical hip dislocation and the anterior mini-open approach.

To compare the magnitude of alpha angle correction achieved by using the Ganz surgical hip dislocation and the anterior mini-open approach.

This is a retrospective study assessing seventy-nine patients identified in a 5-year period. These patients had preoperative radiographic evidence of FAI and underwent surgery by a single surgeon at our institution, a tertiary care center. Patients with missing radiographic documentation, radiographs with insufficient quality which then precluded accurate measurement of the angle α, a diagnosed congenital condition, isolated type II pathology (Pincer), and history of prior surgery were excluded from the study. Either the Ganz surgical hip dislocation or the anterior mini open approach was used. Postoperative radiographic evaluation of the alpha angle between the two surgical methods was done and corrected for age and gender using two-sample t-tests and Chi-square analyses.

A total of 79 patients met the inclusion and exclusion criteria. Forty-seven males (mean age of 35.3, range 16-53) and 32 females (mean age 36.7, range 16-60) were enrolled. Forty-seven patients underwent the anterior mini-open approach, and 32 underwent the Ganz surgical hip dislocation. There were no significant differences in age between the two surgical groups or in pre- and post-operative alpha angles based on patient gender. The mean pre-operative alpha angle for the Ganz surgical hip dislocation group was 88.0 degrees (SD 12.3) and 99.4 degrees (SD 7.2) for the anterior mini-open group. Mean post-operative angles were 49.9 degrees (SD 4.3) for the Ganz surgical hip dislocation and 43.8 (SD 4.3) degrees for the anterior mini-open group. There was a statistically significant difference in patient’s pre-operative and post-operative angles (P = 0.000) with both surgical approaches.

Statistically significant decreases in alpha angle were noted for both surgical techniques, with larger decreases seen in the anterior mini-open group.

• Alpha angle
• Femoroacetabular impingement
• Ganz surgical hip dislocation
• Anterior mini-open

• FAI syndrome
• Hip arthroscopy
• Long term
• Outcome

• FAI
• Femoroacetabular impingement
• Hip arthroscopy
• Outcomes
• Predictors
• Treatment

• Acetabulum/surgery
• Adolescent
• Adult
• Aged
• Arthroscopy/methods
• Child
• Denmark/epidemiology
• Female
• Femoracetabular Impingement/epidemiology
• Femoracetabular Impingement/surgery
• Femur/surgery
• Hip Joint/surgery
• Humans
• Linear Models
• Male
• Middle Aged
• Pain/etiology
• Patient Reported Outcome Measures
• Postoperative Period
• Prospective Studies
• Quality of Life
• Radiography
• Range of Motion, Articular
• Registries
• Risk
• Treatment Outcome
• Young Adult

• cartilage degeneration
• femoroacetabular impingement syndrome
• hip pain
• osteoarthritis
• risk factors

The main purpose of this secondary analysis was to compare the proportion of athletes with moderate-to-extreme difficulties in eight specific sport activities in athletes with optimal versus impaired sport performance after a hip arthroscopy for femoroacetabular impingement syndrome. Subjects were identified in a nationwide registry and invited to answer a return to sport and performance questionnaire, and the Copenhagen Hip and Groin Outcome Score Sport subscale investigating difficulties in eight specific sports activities (HAGOS sport items) as; none, mild, moderate, severe or extreme. Subjects were divided into two groups based on sport performance (optimal or impaired). The proportion of athletes with none-to-mild versus moderate-to-extreme difficulties in the eight specific sport activities was compared between groups. The association between difficulties in sport activities and sport performance were investigated using logistic regression analysis. One hundred and eighty-four athletes (31 athletes with optimal and 153 athletes with impaired sport performance) were included at a mean follow-up of 33.1 ± 16.3 months. Up to six athletes (<20%) with optimal sport performance had moderate-to-extreme difficulties in sport activities. Contrary, 43–108 athletes (28.1–70.6%) with impaired performance had moderate-to-extreme difficulties in sport activities. Furthermore, moderate-to-extreme difficulties in HAGOS sport items: ‘running as fast as you can’ and ‘kicking, skating etc.’ increased the odds (14.7 and 6.1 times, respectively) of having impaired sport performance. Many athletes with impaired sport performance reported moderate-to-extreme difficulties in sport activities, specifically moderate-to-extreme difficulties in ‘running as fast as you can’ and ‘kicking, skating etc.’ were associated with patients having impaired sport performance.

• MINORS
• cam
• pincer
• prospective

• FAI
• arthroscopy
• femoroacetabular impingement
• hip
• quality of life

• Arthralgia/surgery
• Arthroscopy
• Femoracetabular Impingement/surgery
• Hip Joint/surgery
• Humans
• Postoperative Period
• Quality of Life

• Complication
• FAI
• Hip arthroscopy
• Outcome
• Total hip replacement

• Femoroacetabular impingement
• Hip
• Hip muscle strength
• Rehabilitation

• Adult
• Arthroscopy
• Cross-Sectional Studies
• Female
• Femoracetabular Impingement/rehabilitation
• Femoracetabular Impingement/surgery
• Hip/physiology
• Hip/surgery
• Humans
• Male
• Middle Aged
• Muscle Strength
• Muscle, Skeletal/physiology
• Muscle, Skeletal/physiopathology
• Prospective Studies
• Recovery of Function

• HAGOS
• hip arthroscopy
• patient-reported outcome
• return to sport
• sports performance

• HAGOS
• hip arthroscopy
• mHHS
• patient-reported outcome
• reference values
• rehabilitation

• epidemiology
• femoroacetabular impingement
• hip arthroscopy
• minimal clinically important difference
• outcome
• quality of life
• substantial clinical benefit

• Hip arthroscopy
• hip preservation surgery
• non-arthroplasty hip registry
• periacetabular osteotomy

• capsular closure
• femoroacetabular impingement
• hip arthroscopy
• hip instability

• Acetabulum/surgery
• Arthroscopy/adverse effects
• Arthroscopy/methods
• Denmark
• Femoracetabular Impingement/surgery
• Hip Joint/physiopathology
• Hip Joint/surgery
• Humans
• Pain/complications
• Pain Measurement
• Prospective Studies
• Quality of Life
• Reoperation
• Research Design
• Treatment Outcome